1013436690 NPI number — MRS. CATHERINE AMY LANE M.S., P.T.

Table of content: MRS. CATHERINE AMY LANE M.S., P.T. (NPI 1013436690)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013436690 NPI number — MRS. CATHERINE AMY LANE M.S., P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANE
Provider First Name:
CATHERINE
Provider Middle Name:
AMY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SMALLWOOD
Provider Other First Name:
CATHERINE
Provider Other Middle Name:
AMY
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1013436690
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/17/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16254 COMANCHE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENWELL SPRINGS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70739-6205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-306-5195
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16254 COMANCHE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENWELL SPRINGS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70739-6205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-306-5195
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/14/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  07775R , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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